Provider Demographics
NPI:1033823612
Name:SHAHAB, SAMAR (LPC-A)
Entity Type:Individual
Prefix:
First Name:SAMAR
Middle Name:
Last Name:SHAHAB
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13514 BROADMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1970
Mailing Address - Country:US
Mailing Address - Phone:917-703-2944
Mailing Address - Fax:
Practice Address - Street 1:2600 GESSNER RD STE 203
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-3843
Practice Address - Country:US
Practice Address - Phone:917-703-2944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90371101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health